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Home My WebLink About4147DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.74 -2 -14 BOX 32 04147 :a r -:: Jp JL IL 04147 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health May 13, 2005 ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 James Carney 521 Oscawana Lake Road Putnam Valley, NY 10579 Re: Well Permit Application for Carney Property — 114 Lake Drive (T) Putnam Valley Dear Mr. Carney: This Department has approved the well permit for Well #W 17 -05 at the above referenced site. Please be advised that if site conditions and/or site plans change and/or are revised,. thereby compromising the approved separation distances, siting approval of the well must be re- approved by this Department. This letter shall serve as record of approval and by initiating construction of the well covered by this approval of plans, the applicant accepts and agrees to abide by and conform to the following: 1. The well location shall be survey located and staked prior to drilling. 2. The proposed well is approved 80 feet from on -site and/or adjacent subsurface sewage treatment system areas. 3. The well shall be installed with a minimum of 60 feet of casing. 4: -A*, water_ sample -shall be cc, lected:and analyzed, for,cp_liform bacteria after, the well is drilled. The sample result is to be submitted to this Department along with the well completion report within 30 days of completion of the water well. 5. All necessary Town permits for the installation of the well are required to be issued prior to well construction. Should you have any questions, please contact this office. Michael J. Director of MJB:cw Cc: C. Santos, (T) Putnam Valley Insite Engineering . Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL n. r 96 ;_ ,..;..,. x _ _r..r o, • ple8se'prmt'oi[ype' �PCHD f e Yt'## t• Well Location: Street Address: TownNillage Tax Grid #-1, 114 L o K e b 1- Lace Pee K5 k i l l Map Block 7 4 f Lots) -� Well Owner: Name: co-rne'q Address: James 5.11 Oser wa.ha- LaNe koad P V w- Use of Well: I Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling ew Suppl (new dwelling) Deepen Existing Well Detailed Reason S JN u o-f L4 to E e rx ; l i Wafer S for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................:............ ............................... Yes No �✓ Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? ....../ 1% ...................... ............................... Yes No Name of Public Water Supply: i'10 tv E. TownNillage r-n Distance to property from nearest water main: Proposed well location & sources of contamination to provided on separate sheet/plan.a r� cc Date.: _.: alga$ d Applicant Signature:. L.01 ry PERMIT TO CONSTRUCT A WATER WELL v, n-< This permit to construct one water well as set forth above, is granted under provisions of Article lnf the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. / ,z , Date of Issue Permit IssuiA Official: Date of Expiration Title: Permit is Non - Transferrable White copy- HD file; Yellow copy -Building Inspector; Pink copy -Owner' " Orange copy -Well driller Form WP -97 `,P /,-00u -7i Y z:�u B.i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL ., , , -,. .. -. .::- E.�:. .c'�&se}�tin['Orty�a,...�'•m .,mss . .... . •�. v .., , .., �: •x. -_ - 1'Ei°�1�Perin� # ° +(jy..l,� _:��.o�..�:_,. Well Location: Street Address: Town/Village Tax Grid #, 7 y- - / 114 Lake Ft UL We- ReeKskill Map V3 Block `l L/Lot(s) ,)- /� Well Owner: Name: Carne Address: 15-11 JIM" t6t waha- Lake �ftd R V. N. �- Use of Well: I Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling ew Suppl (new dwelling) Deepen Existing Well Detailed Reason 5 h u Lu er Late- a e. i 1 I Wa, +2►- S for Drilling Well Type ✓ Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No ✓ Is well located in a realty subdivision? ...................................... ............................... Yes No ✓ Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? ...... ...................... ............................... Yes No ✓ Name of Public Water Supply: i'\/a N Town/Village r n Distance to property from nearest water main: Proposed well location & sources of contamination to provided on separate sheet/plan. Date: a8 10.5' Applicant Signature:- G� iV < - 1 PERMIT TO CONSTRUCT A WATER WELL t„ r This permit to construct one water well as set forth - above, is granted under provisions of Article 10 bf the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submita Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. / ,e Date of Issue _ �� Permit Issui Official: Date of Expiration Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner,' Orange copy - Well driller Fonn WP -97 t SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LE RETTIL'NIOLINARI, RN'9- 4131N - Associate Commissioner of Health ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH January 4, 2005 1 Geneva Road, Brewster, New York 10509 Mr. Carmello Santos, Supervisor Town of Putnam Valley, Town Hall 265 Oscawana Lake Road Putnam Valley, New York 10579 I.1 Dear Mr. Santos: Lake Peekskill Water System Town of Putnam Valley This Department has received and reviewed the Engineer's Report, dated October 25, 2004 which was prepared by Insite Engineering, for the Lake Peekskill Water System Shutdown. The report is considered acceptable to this Department relative to the system shutdown and potential well sites for the 28 properties that previously relied solely on the seasonal water system. This Department will start processing the well permit applications received to date. Please advise the remainder of the people who have not submitted well permit applications that they must submit a well _permit application to this Department for approval. All well permit applications must be accompanied by the $150.00 application fee, which is to be in the form of a certified check or money order. _ `This ,Department has determined that. the requested waivers. for .the siting _pf _tbe wells are acceptable; All- Wail located less than .100 -fe6t from septic systems are'to be installed'with� additional casing so that a 100 feet minimum separation distance is provided from the septic system to the bottom of the well casing. In addition, all properties with wells shown less than 80 feet from septic systems shall provide ultraviolet disinfection units on the home water system. Finally, all well locations shall be staked out by a NYS Licensed Land Survey prior to drilling. Should you have any questions concerning this matter, please feel free to contact this office. Respectfully, U Michael J. B dzin 1, E Director o fllngmdeii4 cc;: - Insite Engineering JAN 6',2005: Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 T UtIJAK I MEN I OF HEALTH : Division Of Environmental Hq.*h Services TWO COUNTY CENTER — CARMEL, N.Y.. 10512 (914) 225 -3641 ....• .. -. _'�?PLIC � CN TO WATER" itL" WELL LOCATION SIRED A 5 . IUWN /VILLAGULIIY, LAX GRio NUMBER. WELL OWNER NAME. -- 1-7 le G ADDRESS: / J 1z, , /' z G ` ❑ EUoUC USE OF WELL i ary 2 - secondary RESIDENTIAL ❑ BUSINESS ❑ jNDUSTRiAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDON l) - ❑ FARM ❑ TEST /OBSERVATION ❑OTHER (specify) ❑ INSTITUTIONAL ❑ STAND -BY [] AMOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TESTIOBSERVATION ❑ gEPLACE EXISTING SUPPLY ❑ 'DEEPEN EXISTING WELL DRILLED DRIVEN DUG E] GRAVEL OTHER- WELL TYPE IS WELL SITE SUBJECT TO FLOODING ?. _ YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: LOT NO.. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: — YES NO NAME OF PUBLIC•WATER SUPPLY= - TOW -N /V /C DISTANCE TO PROPERTY,FROM NEAREST WATER-MAIN LOCATION SKETCH & SOURCES OF CONTAMINATION. (date) l� (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct�one'water well *as *set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: 19 er. Permit Issuing Official Permit.is - Non - Transferrable 4 a. DAVID D. BRUEN rt'� _d �+ JOHN SIMMONS, M.O. County Executive Deputy Commissioner DEPARTMENT OF HEALTH Division Of Environmental Health Services _ September 22, 1986 Mr. James Carney R.D. # 3 Glermiar Gardens Putnam Valley, New York 10579 Re: Proposed Well.Construction Lake Drive East, Permit #W 32 -86 Carney (Rosenberg) Dear. Mr. Carney: Putnam Valley Review of an application including plans prepared by John Romeo, P.E., dated September 3, 1980 to construct a well for potable water.supply purposes to serve the above property has been completed. Review indicates as.follows: 1. The property `is believed to be presently supplied by the Lake :Peekskill Water .Works with summer water. ''2.. The proposed well is'shown located approximately 86. feet .froin t.17E'_eXt�ng; Sewage c%sp^sal systems -d, t� s puroel whic 3 t . . system consists of seepage pits. 3. The location'of sewage system on adjacent lots are not shown. Recognizing the above.and that a minimm restrictive distance of 150 feet is required between sewage disposal system consisting of seepage pits, and a well, your application for a permit to construct a well on this property is hereby DENIED. trul• ours, ohn ell, Jr., E. .Director Environmental Health Services JK/7P cc: Marvin O'Dell,PV Building Inspector John Romeo JK File TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 NOTE These sketches are based an New York State High Resolubon L E G E N D Approx Location Existing Well A Statewilda Digital Orthalmagery program (2000 pflat —present) and digital tax map Information tram Putnam County These sketches are intended to show Subject Property Approx. Location Proposed 1*11 approximate property lines dwellings and mptk: ewtams for use In assessing possible well locations only Thom sketches are, not intended for any other Approx. Location Direction Of Ground Slope SLOPE purpose and are net intended to be scaled Prior to airfiling any proposed Existing S57S well, the appropriate surveys, designA and permits must be obtained SST Arrow Points Downhill FIMPARM or o4w WA TER SYSTEM SHUTDOWN It ENGINEERING, SURVEYING & AM=T A*-, 04183. tr LANDSC4PEARCHITECTURE, P.C. "A' PLOT PLAN TAX KV 1 3 Gorratt Place * Carmel, Now York 10512 114 LAKE DR. Phone (845) 225-9690 • Fax (4345) 225-9717 83.74-2-14 v , . �. ,.. +:. a- _:. .. +` c K. r .n..� yi:;, .t, : C �. •+,.T� � ., a� � �.0 .. l` 4. i .>' ' � . ,. » W. ..,.,� . �.. s. � J � .. ��. ..n t'.:'t'. "'�X' C1.. y'r. s.. n. Swi ..'T -. p H 0 O ��Ul I{li a 4 MF j^ - +:.5 '7 •'"�ili;M +� A �W 2:`�2 -Syr -�' � \ f� 0 *� J N -p rb. ., ocooao X R � t i �